Sequential anticoagulation with LMWH and DOACs in cirrhotic portal vein thrombosis - 03/03/26
, Myriam Heilani b, Chaarvee Gulia b, Christoph Matthias c, Eva Herrmann d, Vitali Koch e, Leon David Grünewald e, Albrecht Piiper b, Stefan Zeuzem b, Mate Knabe fHighlights |
• | Anticoagulated patients had lower mortality than non-anticoagulated patients. |
• | DOAC therapy was not associated with increased bleeding risk. |
• | Sequential LMWH/DOAC therapy showed favorable event-free survival. |
Abstract |
Background |
Portal vein thrombosis (PVT) is a common complication in patients with liver cirrhosis. While anticoagulation improves outcomes, the optimal treatment strategy, including the role of direct oral anticoagulants (DOACs), remains unclear.
Methods |
In this retrospective cohort study, patients with liver cirrhosis and PVT were analyzed according to anticoagulation strategy (low-molecular-weight heparin [LMWH], DOACs, sequential LMWH/DOAC therapy, or no anticoagulation). Outcomes included bleeding events, portal vein recanalization, mortality, and event-free survival (EFS). Time-to-event analyses and multivariable regression models were applied.
Results |
Anticoagulated patients showed significantly improved survival compared with non-anticoagulated patients. No significant differences in bleeding events, recanalization rates, or mortality were observed between anticoagulation strategies. Sequential LMWH/DOAC therapy was consistently associated with more favorable clinical outcomes, including lower mortality and improved EFS, (mortality HR ≈ 0.4–0.5; EFS log-rank p = 0.01), compared with LMWH monotherapy, although statistical significance was not reached. DOAC therapy was not associated with increased bleeding risk. Portal vein recanalization was associated with increased bleeding risk, and PVT recurrence was linked to higher mortality.
Conclusions |
Anticoagulation is associated with improved survival in patients with cirrhosis and PVT. DOACs appear safe in carefully selected patients, and sequential LMWH/DOAC therapy may offer clinical benefit, warranting confirmation in prospective studies.
Le texte complet de cet article est disponible en PDF.Keywords : Portal vein thrombosis, Liver cirrhosis, Anticoagulation, Direct oral anticoagulants, Low-molecular-weight heparin, Event-free survival, Survival analysis, Competing risk analysis, Fine–Gray model, Cox proportional hazards model
Plan
Vol 50 - N° 4
Article 102792- avril 2026 Retour au numéro
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